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Activity Disclaimer
The material presented here is being made available by the DPC Summit Co-organizers for educational
purposes only. This material is not intended to represent the only, nor necessarily best, methods or
processes appropriate for the practice models discussed. Rather, it is intended to present statements and
opinions of the faculty that may be helpful to others in similar situations.
Any performance data from any direct primary care practices cited herein is intended for purposes of
illustration only and should not be viewed as a recommendation of how to conduct your practice.
The DPC Summit Co-Organizers disclaim liability for damages or claims that might arise out of the use of the
materials presented herein, whether asserted by a physician or any other person. While the DPC Summit
Co-Organizers have attempted to ensure the accuracy of the data presented here, these materials may
contain information and/or opinions developed by others, and their inclusion here does not necessarily imply
endorsement by any of the DPC Summit Co-Organizers.
The DPC Summit Co-Organizers are not making any recommendation of how you should conduct your
practice or any guarantee regarding the financial viability of DPC conversion or practice.
Faculty Disclosure
It is the policy of the DPC Summit Co-Organizers that all individuals in a position to
control content disclose any relationships with commercial interests upon
nomination/invitation of participation. Disclosure documents are reviewed for potential
conflict of interest (COI), and if identified, conflicts are resolved prior to confirmation of
participation. Only those participants who had no conflict of interest or who agreed to an
identified resolution process prior to their participation were involved in this CME activity.
All faculty in a position to control content for this session have indicated they
have no relevant financial relationships to disclose.
The content of this material/presentation in this CME activity will not include discussion of
unapproved or investigational uses of products or devices.
Learning Objectives
• Define opportunities to expand the scope of DPC practice in
both outpatient and inpatient settings
• Identify the added value of expanding your scope of practice
• Identify resources to help DPC physicians learn and perfect
skills to achieve scope expansion.
Please visit aafp3.cnf.io and as we go, submit your questions. Audience
members can upvote and downvote questions and we’ll tackle the most
requested questions at the end. This is your chance to heckle us or actually ask
us something you want to learn.
HOW TO INTERACT WITH US
BECAUSE WE HAVE HORRIBLE SOCIAL SKILLS
Either way, you win!
AES Question
aafp3.cnf.io
WHO ARE YOU
GETTING TO KNOW OUR AUDIENCE
Prepare for rapid-fire
audience participation
Do you practice DPC?
a) Yes
b) No, and I won’t. I think I’m at the wrong conference.
c) Can’t wait to start (Planning DPC)
d) I’m mad as hell, and I can’t take it anymore (“DPC-Curious”)
e) I’m not even a doctor, I just came here for the food and so I
could meet all these amazing, smiling people, especially Drs.
Tomsen and Lassey, and so I could hear this talk.
Live Content Slide
When playing as a slideshow, this slide will display live content
Poll: Do you practice DPC?
WWW.ANTIOCHMED.COM
WHO WE ARE GETTING TO KNOW YOUR PRESENTERS
Nicholas Tomsen, MD
DR. TOMSEN THREE THINGS YOU DIDN’T KNOW
• Takes efficiency and common sense very seriously
• Legally shortened name from Thompsen in favor of phonetic spelling
and to eliminate “stupid, time consuming silent letters”
• Stopped shaving and still wears glasses he bought in the 1950s
• Attaches JAMA covers to MAD magazines and comic books to
get away with reading them at work
• Moonlights as a Lucha Libre Wrestler for exercise, and enjoys
the anonymity the mask provides.
• Heavily tattooed.
DR. TOMSEN AFTER HOURS
WWW.HOLTONDIRECTCARE.COM
WHO WE ARE GETTING TO KNOW YOUR PRESENTERS
DR. LASSEY THREE THINGS YOU DIDN’T KNOW
• He hasn’t always been sasquatch-sized
• But currently takes full advantage, applying Vance-a-
nomics negotiating strategies
• He wears fur-lined coats at every chance
• Claims it for his “sensory processing disorder”
treatment
• We know who he takes his fashion advice from
• Diet Mountain Dew is always an appropriate
bargaining tool
Broadening your OUTPATIENT scope
AES Question
aafp3.cnf.io
Regarding Outpatient Care (“OP”):
a) DPC Doc and have a very broad scope of OP care already
b) DPC Doc and am open to broadening my scope of OP care
c) Planning DPC with a wide OP spectrum of care
d) Planning DPC and want to learn how to broaden my scope of
practice
e) Planning DPC, but don’t mind a watered down practice, and I
embrace the term “Provider”
I am:
Live Content Slide
When playing as a slideshow, this slide will display live content
Poll: Regarding Outpatient Care (“OP”): I am....
• It’s the right thing to do
• Adds value
• If you want something done right...do it yourself.
• Referrals and Retention
• Job satisfaction, lifelong learning
• Potential Additional Revenue
OUTPATIENT WHY BROADEN YOUR OUTPATIENT SCOPE?
Accidental GSW to the Hand
*Images used with patient permission
Hand Wound - Day 4
Hand Wound - Day 10
Hand Wound - Day 14
Hand Wound - Day 20
Hand Wound - Day 28
Hand Wound - Day 35
Hand Wound - Current
Patient
Recruitment &
Retention
OUTPATIENT HOW YOU CAN ADD TO YOUR OUTPATIENT SCOPE
Procedures
• Joint Injections
• Lesion removal/biopsy
• Cryotherapy
• Vasectomy
• Hemorrhoid excision
• Cosmetic Procedures
• Casting
• Abscess I&D
• Minor surgery
Office Services
• OMT
• Immigration Physicals
• DOT Physicals
• Stress Testing/V02 Testing
• Migraine Treatment
• Bone Density Testing
• Body Composition Analysis
• Travel Medicine
• Non-member services
Submit questions to: aafp3.cnf.io
OUTPATIENT HOW YOU CAN ADD TO YOUR OUTPATIENT SCOPE
Consulting
• 2nd opinions
• Interpreting outside medical
reports from medical jargon
to English
• Sleep Medicine - CPAP
Counseling
• Therapy / Counseling
• Marriage Counseling
• Family Counseling
• Dietary/Exercise
Counseling
• Sex Counseling
• Sleep Hygiene
Submit questions to: aafp3.cnf.io
OUTPATIENT
HOW YOU CAN ADD TO YOUR OUTPATIENT SCOPE
•
• Mentoring/Proctoring
• RubiconMD
• YouTube / Vimeo etc Videos
Submit questions to: aafp3.cnf.io
Insert freeze-frame screencap
of Aponeurotomy HERE Insert similar picture of YOUR
Aponeurotomy HERE
OUTPATIENT
HOW YOU CAN ADD TO YOUR OUTPATIENT SCOPE
• Procedures for Primary
Care: Pfenniger & Fowler
• Fracture Management for
Primary Care: Eiff & Hatch
• Social Networking
Submit questions to: aafp3.cnf.io
OUTPATIENT EASY PLACES TO START ADDING VALUE
• Cryotherapy
• $26.89 on Amazon
$4.18 Homemade Shave Biopsy Kit
$7 to $17 Joint Injection kit
OUTPATIENT EASY PLACES TO START ADDING VALUE
$4 Incision and Drainage Kit
OUTPATIENT EASY PLACES TO START ADDING VALUE
Home Sleep Study: $175
(not always even
necessary)
Auto-CPAP and supplies
(Cadillac): $650
(Used): $20
$650-825 Full OSA Diagnosis and treatment
OUTPATIENT EASY PLACES TO START ADDING VALUE
Adding INPATIENT Care
AES Question
aafp3.cnf.io
Regarding Inpatient Care (“IP”):
a) DPC and I do IP
b) DPC, and don’t do IP and don’t want to
c) DPC, I want to do IP but there are obstacles in my way
d) Not DPC but will do IP care if at all possible
e) Not DPC but don’t want to do IP after I start
I am:
Live Content Slide
When playing as a slideshow, this slide will display live content
Poll: Regarding Inpatient Care (“IP”): I am....
DPC Inpatient Care vs Hospitalists
(OPINION SURVEY):
A: DPC Docs can do IP better than hospitalists because of time
availability and increased continuity.
B: Hospitalists can do IP better than DPC docs because they do
it all day long for a living, which I believe somehow compensates
for crappy continuity.
Live Content Slide
When playing as a slideshow, this slide will display live content
Poll: DPC Inpatient Care vs Hospitalists (OPINION SURVEY):
INPATIENT WHY BROADEN YOUR INPATIENT SCOPE
• Value
• You know your patient better than the hospitalist
• Coordination of care and continuity to outpatient setting
• The hospitalists aren’t the only ones with UpToDate
• Doing social rounds? Why not just manage?
• Your patients will be texting/calling you from the hospital anyway!
OWNING OUR BIAS
Submit questions to: aafp3.cnf.io
INPATIENT BARRIERS AND DIFFICULTIES
• Hospital Privileges
• Easiest to maintain current privileges or obtain out of residency
• May require board certification
• Occasional turf battles
• Administrators who don’t understand Medicare Opt In/Out
• May require Med-Staff meetings and/or EMR training/use
• Malpractice Insurance
• Insurance Contracts
Submit questions to: aafp3.cnf.io
• Just Do It (apply for privileges & take care of your patients)
• Moonlight, cover ER shifts
• Cover for other DPC docs in your area
• Residency Teaching and Coverage
• Peer Review
INPATIENT HOW TO GET YOUR FOOT IN THE DOOR
Submit questions to: aafp3.cnf.io
OBSTETRICS WHY BROADEN YOUR OBSTETRIC SCOPE
• Huge value to young/healthy families
• Pregnant patient will ask questions anyway
• You are more accessible than the OB
• Exhilarating and Challenging
• You are a FAMILY DOCTOR and FAMILIES have BABIES
• Babies on Facebook are the best marketing there is
Submit questions to: aafp3.cnf.io
• Privileges and Turf Battles
• Malpractice Insurance
• Maintaining Skills
• Numbers
OBSTETRICS CHALLENGES
Submit questions to: aafp3.cnf.io
• Need Privileges, Malpractice - Ideally Inpatient Cash Pricing
• Look for niche communities to market
• Cost sharing ministries
• Mom groups
• Uninsured patients
• Sell accessibility and continuity
• It may be more expensive with you, especially with deductible <$3-4k
• Find partners that will bill insurance for ancillary services
• Labs, ultrasounds, PAPs, etc
OBSTETRICS IMPLEMENTING OB CARE
Submit questions to: aafp3.cnf.io
Questions?
Submit
questions to:
aafp3.cnf.io
Don’t forget to
evaluate this
session, and
tell us how
amazing it
was!
Contact Information
Vance Lassey, MD
doc@holtondirectcare.com
www.holtondirectcare.com
Nicholas Tomsen, MD
ntomsen@antiochmed.com
www.antiochmed.com
Nicholas Tomsen, MD - DPC Changed the Rules: Reclaim Full-Scope Practice - DPC Summit 2018

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Nicholas Tomsen, MD - DPC Changed the Rules: Reclaim Full-Scope Practice - DPC Summit 2018

  • 1.
  • 2.
  • 3. Activity Disclaimer The material presented here is being made available by the DPC Summit Co-organizers for educational purposes only. This material is not intended to represent the only, nor necessarily best, methods or processes appropriate for the practice models discussed. Rather, it is intended to present statements and opinions of the faculty that may be helpful to others in similar situations. Any performance data from any direct primary care practices cited herein is intended for purposes of illustration only and should not be viewed as a recommendation of how to conduct your practice. The DPC Summit Co-Organizers disclaim liability for damages or claims that might arise out of the use of the materials presented herein, whether asserted by a physician or any other person. While the DPC Summit Co-Organizers have attempted to ensure the accuracy of the data presented here, these materials may contain information and/or opinions developed by others, and their inclusion here does not necessarily imply endorsement by any of the DPC Summit Co-Organizers. The DPC Summit Co-Organizers are not making any recommendation of how you should conduct your practice or any guarantee regarding the financial viability of DPC conversion or practice.
  • 4. Faculty Disclosure It is the policy of the DPC Summit Co-Organizers that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflict of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity. All faculty in a position to control content for this session have indicated they have no relevant financial relationships to disclose. The content of this material/presentation in this CME activity will not include discussion of unapproved or investigational uses of products or devices.
  • 5. Learning Objectives • Define opportunities to expand the scope of DPC practice in both outpatient and inpatient settings • Identify the added value of expanding your scope of practice • Identify resources to help DPC physicians learn and perfect skills to achieve scope expansion.
  • 6. Please visit aafp3.cnf.io and as we go, submit your questions. Audience members can upvote and downvote questions and we’ll tackle the most requested questions at the end. This is your chance to heckle us or actually ask us something you want to learn. HOW TO INTERACT WITH US BECAUSE WE HAVE HORRIBLE SOCIAL SKILLS Either way, you win!
  • 8. WHO ARE YOU GETTING TO KNOW OUR AUDIENCE Prepare for rapid-fire audience participation
  • 9. Do you practice DPC? a) Yes b) No, and I won’t. I think I’m at the wrong conference. c) Can’t wait to start (Planning DPC) d) I’m mad as hell, and I can’t take it anymore (“DPC-Curious”) e) I’m not even a doctor, I just came here for the food and so I could meet all these amazing, smiling people, especially Drs. Tomsen and Lassey, and so I could hear this talk.
  • 10. Live Content Slide When playing as a slideshow, this slide will display live content Poll: Do you practice DPC?
  • 11. WWW.ANTIOCHMED.COM WHO WE ARE GETTING TO KNOW YOUR PRESENTERS Nicholas Tomsen, MD
  • 12. DR. TOMSEN THREE THINGS YOU DIDN’T KNOW • Takes efficiency and common sense very seriously • Legally shortened name from Thompsen in favor of phonetic spelling and to eliminate “stupid, time consuming silent letters” • Stopped shaving and still wears glasses he bought in the 1950s • Attaches JAMA covers to MAD magazines and comic books to get away with reading them at work • Moonlights as a Lucha Libre Wrestler for exercise, and enjoys the anonymity the mask provides. • Heavily tattooed.
  • 14. WWW.HOLTONDIRECTCARE.COM WHO WE ARE GETTING TO KNOW YOUR PRESENTERS
  • 15. DR. LASSEY THREE THINGS YOU DIDN’T KNOW • He hasn’t always been sasquatch-sized • But currently takes full advantage, applying Vance-a- nomics negotiating strategies • He wears fur-lined coats at every chance • Claims it for his “sensory processing disorder” treatment • We know who he takes his fashion advice from • Diet Mountain Dew is always an appropriate bargaining tool
  • 18. Regarding Outpatient Care (“OP”): a) DPC Doc and have a very broad scope of OP care already b) DPC Doc and am open to broadening my scope of OP care c) Planning DPC with a wide OP spectrum of care d) Planning DPC and want to learn how to broaden my scope of practice e) Planning DPC, but don’t mind a watered down practice, and I embrace the term “Provider” I am:
  • 19. Live Content Slide When playing as a slideshow, this slide will display live content Poll: Regarding Outpatient Care (“OP”): I am....
  • 20. • It’s the right thing to do • Adds value • If you want something done right...do it yourself. • Referrals and Retention • Job satisfaction, lifelong learning • Potential Additional Revenue OUTPATIENT WHY BROADEN YOUR OUTPATIENT SCOPE?
  • 21. Accidental GSW to the Hand *Images used with patient permission
  • 22. Hand Wound - Day 4
  • 23. Hand Wound - Day 10
  • 24. Hand Wound - Day 14
  • 25. Hand Wound - Day 20
  • 26. Hand Wound - Day 28
  • 27. Hand Wound - Day 35
  • 28. Hand Wound - Current Patient Recruitment & Retention
  • 29. OUTPATIENT HOW YOU CAN ADD TO YOUR OUTPATIENT SCOPE Procedures • Joint Injections • Lesion removal/biopsy • Cryotherapy • Vasectomy • Hemorrhoid excision • Cosmetic Procedures • Casting • Abscess I&D • Minor surgery Office Services • OMT • Immigration Physicals • DOT Physicals • Stress Testing/V02 Testing • Migraine Treatment • Bone Density Testing • Body Composition Analysis • Travel Medicine • Non-member services Submit questions to: aafp3.cnf.io
  • 30. OUTPATIENT HOW YOU CAN ADD TO YOUR OUTPATIENT SCOPE Consulting • 2nd opinions • Interpreting outside medical reports from medical jargon to English • Sleep Medicine - CPAP Counseling • Therapy / Counseling • Marriage Counseling • Family Counseling • Dietary/Exercise Counseling • Sex Counseling • Sleep Hygiene Submit questions to: aafp3.cnf.io
  • 31. OUTPATIENT HOW YOU CAN ADD TO YOUR OUTPATIENT SCOPE • • Mentoring/Proctoring • RubiconMD • YouTube / Vimeo etc Videos Submit questions to: aafp3.cnf.io
  • 32. Insert freeze-frame screencap of Aponeurotomy HERE Insert similar picture of YOUR Aponeurotomy HERE
  • 33. OUTPATIENT HOW YOU CAN ADD TO YOUR OUTPATIENT SCOPE • Procedures for Primary Care: Pfenniger & Fowler • Fracture Management for Primary Care: Eiff & Hatch • Social Networking Submit questions to: aafp3.cnf.io
  • 34. OUTPATIENT EASY PLACES TO START ADDING VALUE • Cryotherapy • $26.89 on Amazon
  • 35. $4.18 Homemade Shave Biopsy Kit
  • 36. $7 to $17 Joint Injection kit OUTPATIENT EASY PLACES TO START ADDING VALUE
  • 37. $4 Incision and Drainage Kit OUTPATIENT EASY PLACES TO START ADDING VALUE
  • 38. Home Sleep Study: $175 (not always even necessary) Auto-CPAP and supplies (Cadillac): $650 (Used): $20 $650-825 Full OSA Diagnosis and treatment OUTPATIENT EASY PLACES TO START ADDING VALUE
  • 41. Regarding Inpatient Care (“IP”): a) DPC and I do IP b) DPC, and don’t do IP and don’t want to c) DPC, I want to do IP but there are obstacles in my way d) Not DPC but will do IP care if at all possible e) Not DPC but don’t want to do IP after I start I am:
  • 42. Live Content Slide When playing as a slideshow, this slide will display live content Poll: Regarding Inpatient Care (“IP”): I am....
  • 43. DPC Inpatient Care vs Hospitalists (OPINION SURVEY): A: DPC Docs can do IP better than hospitalists because of time availability and increased continuity. B: Hospitalists can do IP better than DPC docs because they do it all day long for a living, which I believe somehow compensates for crappy continuity.
  • 44. Live Content Slide When playing as a slideshow, this slide will display live content Poll: DPC Inpatient Care vs Hospitalists (OPINION SURVEY):
  • 45. INPATIENT WHY BROADEN YOUR INPATIENT SCOPE • Value • You know your patient better than the hospitalist • Coordination of care and continuity to outpatient setting • The hospitalists aren’t the only ones with UpToDate • Doing social rounds? Why not just manage? • Your patients will be texting/calling you from the hospital anyway! OWNING OUR BIAS Submit questions to: aafp3.cnf.io
  • 46. INPATIENT BARRIERS AND DIFFICULTIES • Hospital Privileges • Easiest to maintain current privileges or obtain out of residency • May require board certification • Occasional turf battles • Administrators who don’t understand Medicare Opt In/Out • May require Med-Staff meetings and/or EMR training/use • Malpractice Insurance • Insurance Contracts Submit questions to: aafp3.cnf.io
  • 47. • Just Do It (apply for privileges & take care of your patients) • Moonlight, cover ER shifts • Cover for other DPC docs in your area • Residency Teaching and Coverage • Peer Review INPATIENT HOW TO GET YOUR FOOT IN THE DOOR Submit questions to: aafp3.cnf.io
  • 48. OBSTETRICS WHY BROADEN YOUR OBSTETRIC SCOPE • Huge value to young/healthy families • Pregnant patient will ask questions anyway • You are more accessible than the OB • Exhilarating and Challenging • You are a FAMILY DOCTOR and FAMILIES have BABIES • Babies on Facebook are the best marketing there is Submit questions to: aafp3.cnf.io
  • 49.
  • 50. • Privileges and Turf Battles • Malpractice Insurance • Maintaining Skills • Numbers OBSTETRICS CHALLENGES Submit questions to: aafp3.cnf.io
  • 51. • Need Privileges, Malpractice - Ideally Inpatient Cash Pricing • Look for niche communities to market • Cost sharing ministries • Mom groups • Uninsured patients • Sell accessibility and continuity • It may be more expensive with you, especially with deductible <$3-4k • Find partners that will bill insurance for ancillary services • Labs, ultrasounds, PAPs, etc OBSTETRICS IMPLEMENTING OB CARE Submit questions to: aafp3.cnf.io
  • 52. Questions? Submit questions to: aafp3.cnf.io Don’t forget to evaluate this session, and tell us how amazing it was! Contact Information Vance Lassey, MD doc@holtondirectcare.com www.holtondirectcare.com Nicholas Tomsen, MD ntomsen@antiochmed.com www.antiochmed.com